[Question #2993] Hiv test

41 months ago
Hello ,
I am worried about a possible hiv exposure . I was extremely intoxicated and had sex with an Asian massage parlor worker in the United States. Was not sure if protection was used. I tested at a hospitalwhich  used antibody and p24 at 16 days hiv negative and clayamidia negative . Then at a clinic at 29 days using the alere duo test also negative and negative for hep c. Then tested at a lab using the 4 generation test at 6 weeks 43 days to be exact also negative hiv and hep c . Do I need to re test again at six weeks because of the CDC guildlines I can't seem to get over this because CDC says 3 months. Thanks 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
41 months ago
Welcome to the forum. Thanks for your question and your confidence in our services.

You needn't worry:  for sure you do not have HIV. The current standard HIV tests, including the ones you had, are among the most accurate diagnostic tests ever developed, for any medical condition. When done sufficiently long after the last possible exposure, the results are 100% reliable. The antigen-antibody ("4th generation") HIV tests you had are conclusive at 6 weeks. CDC's continued advice about testing at 3 months is just being conservative and careful. In fact, the CDC scientists primarily responsible for HIV test evaluation recently published a commentary acknowledging conclusive results well before 3 months:  below are links to that commentary as well as a comprehensive review by other HIV testing experts about the performance of the current tests. In other words, your test results were conclusive at 43 days. Because the test results are conclusive, your risk at the time of exposure doesn't matter. Even if you had unprotected sex and even if your partner had HIV, your test results prove you weren't infected.

https://www.ncbi.nlm.nih.gov/pubmed/29140890
https://www.ncbi.nlm.nih.gov/pubmed/29140891

If your chlamydia test was a standard urine test, it also is conclusive. It probably included gonorrhea testing as well. If so, it is also conclusive. Hep B and C were virtually zero risk as well, and those results also are conclusive. The only thing you don't mention is syphilis testing:  if done at 6+ weeks after exposure, that also is conclusive. If not done, you should consider it now. Almost certainly it will be negative, but better safe than sorry!

I hope these comments have been helpful. Let me know if anything isn't clear. Best wishes and stay safe--  

HHH, MD
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41 months ago
Thanks doctor you have been  a huge help the other question I had that worried me was asome symptoms  appeared two weeks after exposure a constant nasal drip which had me clearing my throats for weeks that did go away but also I currently have been dealing with a strange pins and needles and odd sensations through my body finger, toes ,leg arms that hasn't went away for almost 3 weeks was worried based on what I saw online that Perphiral neuropathy could be an early hiv sign any thoughts and advice on these symptoms  maybe anxiety related?much appreciated 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
41 months ago
As I said, your test results overrule your symptoms and prove that they are not due to HIV. Anyway, they don't sound at all like ARS, which does not cuase nasal drip or the pins and needles sensations you describe. And neuropathy is an issue in advanced HIV/AIDS, not ARS. And no other STD would cause these things either. If your symptoms continue or you otherwise remained concerned about them, see your doctor. But they are not due to any infection from the sexual encounter (unless you happened to catch a cold from your partner).

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41 months ago
Ok great the other confusion I have is the antibody and p24 always referred to as 4th generation test ? Is there such thing as a p24 antigen test that is fourth generation and a antibody test that is a 3rd  or earlier. Seems I have had the antigen and antibody  so would that be 4 generation  technology for both anitgen and antibody ?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
41 months ago
The "generation" terminology is not so useful any more; CDC recommends against so characterizing the standard HIV tests, partly because it fosters uncertainties exactly of the sort you are aking about.

By usual terminology, 4th gen has meant the combination of p24 antigen plus antibody testing. In the 4th gen tests, the antibody component is the same as that in 3rd generation tests, an detects antibodies of both IgG and IgM classes. It is possible to test for p24 without antibody, but such tests don't fit into the "generation" concept. 

The take-home message is that the best and now pretty much routinely recommended test is almost always one of the antigen-antibody tests.

That concludes the two follow-up comments and replies included with each question and so winds up this thread. I hope the discussion has been useful.
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